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Air Trapping in Heart-Lung Transplant Recipients: Variability of Anatomic Distribution and Extent at Sequential Expiratory Thin-Section CT¹

¹ From the Department of Radiology, University of Vienna, Waehringer Guertel 18–20, A-1090 Vienna, Austria (A.A.B.); and Departments of Chest Medicine (A.V.M., M.E.) and Radiology (P.S., P.A.G.) and Statistical Unit, Institute of Interdisciplinary Research in Human and Molecular Biology (V.D.M.), University of Brussels, Belgium. Received July 10, 2002; revision requested August 29; final revision received March 18, 2003; accepted April 2. Address correspondence to A.A.B. (e-mail: alexander.bankier@univie.ac.at).

View larger version (72K): [in a new window]   Figure 1. Scoring the anatomic distribution of air trapping. For assessing the reproducibility of the anatomic distribution of air trapping, a corresponding pair of transverse CT examination results was assigned to one of the four categories illustrated. Assignment was based on section-by-section comparison, and air trapping was considered as newly appeared as soon as it was detected in one secondary pulmonary lobule on one pair of corresponding CT sections in an examination. Dark octagons represent air trapping. H = heart, S = spine. Category 1 indicates that there is no air trapping at both CT examinations or there is air trapping in identical secondary pulmonary lobules at both CT examinations; category 2, that there is air trapping in identical secondary pulmonary lobules at both CT examinations and additional secondary lobules show newly appeared air trapping at the second CT examination; category 3, that previously evident air trapping is no longer visible at the second CT examination and no air trapping has newly appeared; and category 4, that previously evident air trapping is no longer visible at the second CT examination and secondary lobules other than those observed at the first CT examination show newly appeared air trapping.

View larger version (90K): [in a new window]   Figure 2. Anatomic distribution and extent of air trapping. Transverse expiratory CT sections obtained at the level of the right lower lobe of a heart-lung transplant recipient with BOS at, A, the first CT examination, B, the second CT examination, and, C, the third CT examination show that both anatomic distribution and extent of air trapping (visible as areas of low attenuation) are reproducible between examinations.